Highlights of Discussion on Mandatory Bicycle Helmet Laws

This document contains highlights of discussion regarding Mandatory Helmet
Legislation for Bicyclists on Usenet newsgroups back in 1994.

From: Noel Weyrich
Newsgroups: dc.biking
Date: 28 Apr 94 21:59 PDT
Subject: Re: Helmet Laws
scotty@verdix.com writes:
S> When you look at a car driver, required to be strapped in and having a
S> fairly good chance of being protected by an air-bag in most otherwise
S> head-damaging collisions, you don't get the impression that a helmet
S> requirement is going to be worth the legislation for the minor
S> improvement it would make

Minor improvement? 40,000 Americans die in auto accidents ever year, most
are head injuries. A head is completely unprotected in side crashes, in
crashes that crumple the front end, etc. Please, read the paper. Why do
race drivers wear helmets? They're strapped in!

On the other hand, of the 900 cyclists who died last year in America, many
were wearing helmets. Three of the six cyclists who have died in the
Philadelphia area in the last two years were wearing helmets. One was hit by
a car with a vinyl roof. The TV news showed the helmet imprint, GIRO,
spelled backwards, pressed permanently into the damaged vinyl roof.

I'm merely saying that the rational defense of bicycle helmets does not make
sense because if we really want to stop deaths, we should start with the
major causes of death. Here are the figures from the National Trauma
Society.

Brain injury is the leading killer of young adults. 75,000 Americans die of
traumatic brain injuries each year. Between 70,000 and 90.000 will endure
lifelong debilitating loss of function, each year. Young males, 15-24 highest
risk group. Causes:

50 percent motor vehicle accidents

21 percent falls

12 percent assaults

10 percent sports (bicycles are a tiny portion of this category)

What is rational public policy here? Where do we start. Helmets for
motorists (or just their child passengers) seems to be the most promising!

Good, unbiased information is hard to find. I suggest Cycling Towards
Health and Safety by the British Medical Association (Oxford University
Press, 1992, ISBN 0-19-286151-4). Although not available in the States, you
might have better luck in Canada. The Orange County (Calif.) Bicyclist
Coalition distributes it here. They sum it up nicely: "The question of helmet
goes to the heart of policy-making for cyclists. Sooner rather than later it
should be realized that the route to encouraging cycling and making it safer
lies in the provision of safer cycling networks, enforced lower speed-limits,
and in changing the attitudes and behavior of drivers rather than cyclists."
(p.88)

Be prepared for a tough battle. It is hard to oppose "safety." The proponents
will trot out statistic like helmets prevent 80 percent of head injuries, but
neglect to say that only 2 percent of all head injuries are major (that
is, a concussion lasting more than 15 minutes, and remember symptoms of a
minor concussion are nausea and wooziness). They ignore that in 3/4 of all
serious injuries and fatalities a car is involved (BMA, p 47), "in
collisions with motor vehicles other injuries can assume greater significance
and may indeed cause death" (BMA, p 128), and that a pedestrian or cyclist
struck at speeds greater than 30 mph is likely to suffer severe or fatal
injuries but at speeds less than 20 mph the casualties are likely to be
slight (BMP, p 122).

This thread has been going strong for a long time; this response is to several
postings and is 300 lines.

pgn@waikato.ac.nz writes:
PGN> I have seen two cases, where cyclists have fallen off their
PGN> bikes from no fault of there own and hit their head. If they
PGN> weren't wearing their helmets they would either be talking
PGN> gibberish, and dribbling heaps, or dead by now!!!.

The mythology surrounding helmets and the degree of protection they offer is
astounding. Science is not about repeating anecdotes--in reality, more than
95 percent of the cyclists fatalities in the us and uk, (and I suspect, new
zealand) involve motor vehicles. Your friends might have been shaken up
pretty badly without a helmet, but a car has to be involved for them to have
been killed.

Peter Epstein writes:
PE> So, why don't you try to get the cycle manufacturers and other
PE> bike groups to get the message out that helmets do indeed
PE> work? Maybe collect some statistics to show their effectiveness.

One reason we have these "helmet wars" on the net is that these statistics
show wildly different results. One paper shows a table of estimates of lives
helmets would save from a half-dozen or so papers. They range all the way
from zero to 85 percent. Some even show that helmeted cyclists are involved in
*more* accidents.

This latter concept is called risk compensation or homeostasis. Other examples
are personal injury rates going up in airbag-equipped cars and anti-lock
brake-equipped cars getting in more accidents. Proponents of this concept
believe that helmets alter the behavior of the bicycle and motor vehicle
operators, either consciously or unconsciously. You can test this theory; go
for a mountain bike ride on the gnarliest trail without a helmet and see if
you ride slower.

A bicycle helmet is intended to reduce the impact forces. However, it can't
protect against impacts that a motor vehicle can impart. To protect against a
20 mph impact, you need 6.5 inches of foam; 30 mph, 15 inches; 40 mph, 29
inches. At a half-inch of foam, a bicycle helmet adds little protection to
that that nature provides.

A Bell Sport 2000 motorcycle helmet weighs 1700 grams, a Giro Ventoux bicycle
helmet weighs 200 grams. Yet the motorcycle helmet only protects against a 12
mph impact. You are kidding yourself if you believe a bicycle helmet will save
you in the event of a motor vehicle collision.

Mark Hoppe writes:
MH> Regarding helmet laws: they protect the PUBLIC. There is no
MH> question of a helmet's safety value. BECAUSE the law
MH> ALLOWS it, you are granted the PRIVILEGE of riding on
MH> PUBLIC roads. To do so, you must follow the laws: stop at stop
MH> signs, use signals, have reflectors, and yes, require YOU to
MH> wear a helmet. Surprisingly, the law has not yet required
MH> licensing for bicycles. They are not infringing on your rights,
MH> they're granting a privilege, which carries certain
MH> requirements. Wearing a helmet can be one of them.

Whoa.

Highways are public highways, built and maintained for the use of all the
people. The legal handbook "American Jurisprudence" states "all persons have
an equal RIGHT to use [the highways] for purposes of travel."

Operating a motor vehicle on highways is a PRIVILEGE because you endanger
others.

MH> What I WOULD like to see is mandatory helmet laws for
MH> children below a certain age. They are not old enough to
MH> understand all the issues and make a mature decision, and in
MH> some cases, neither are the parents.

From the LA Times, December 12, 1993: "Numerous studies have confirmed that
young children under 8 are not physically, behaviorally or cognitively able to
be safe pedestrians or cyclists.

"Children ... view traffic situations differently than adults. Young children
do not perceive danger. They can't properly judge the speed or distance of a
moving car and have no idea that a car needs room to
stop. Their field of visions is one-third narrower than that of adults.
Children think because they can see a car, the driver can see them. They
can't readily determine the direction a sound is coming from. Children
react spontaneously and unexpectedly. They are in perpetual motion and easily
distracted."

They go on to explain that pedestrian accidents are the leading cause of
severe injury in young children. (N.B. the phrase "pedestrian accidents."
Pedestrians injuries are not caused by tripping on shoe laces--they are being
struck by cars.)

Child cyclists are just a sub-set of child pedestrians. Developing a solution
for these injuries/fatalities will require a more comprehensive solution than
just requiring child cyclists to wear helmets.

Should we require helmets for pedestrian children? Keep in mind that severe
injuries typically include more than just those injuries a helmet could
prevent. A pedestrian/cyclist hit at more than 20 mph will likely die of
injuries that a helmet cannot prevent.

I wonder if that could have anything to do with the fact that
there are now 90% fewer Sydney secondary schoolgirls cycling
to school than before helmets were made mandatory?
I mean, 9 out of 10 of them wouldn't give up cycling to
school because helmets mess up your hair, would they?

From: D. Robinson
Newsgroups: rec.bicycles.soc
Subject: Re: Mandatory Helmet Legislation
Date: 1 Dec 93 06:32:20 GMT
mjvande@PacBell.COM (Mike Vandeman, commenting on another cyclist's post)
MV> ??> At the risk of re-igniting the helmet wars, I'll state that one
MV> ??> of the reasons that I feel safer riding around Seattle than
MV> ??> in suburban or rural king county is because of the sheer number
MV> ??> of bicyclists in the City, many of whom are unhelmeted.
MV> ??> Motorists in Seattle are used to the presence of cyclists,
MV> ??> and accept them as part of the street scene. Forcing the
MV> ??> unhelmeted cyclists off the streets would only make cycling
MV> ??> more dangerous.
MV> Not very good use of logic. Where is the proof that even one
MV> bicyclist would stop riding because of such a law?

I can't believe you wrote that! Have you not seen the counts of numbers of
cyclists pre and post mandatory helmet legislation. In NSW, for example, they
did counts of children's cycling 2 months before and 10 months after mandatory
helmets, and found and overall reduction of 38% in numbers of cyclists
counted.

But if that doesn't convince you, a group in Darwin actually stopped people
in the street and asked them if they cycled, or used to cycle and the effect
mandatory helmets had on their cycling behaviour. 22% claimed to have
given up cycling because of the helmet legislation, and 20 or 30% said they
cycled less. Do you really need any more proof?

MV> How would you answer the misery of a mother whose child was
MV> severely injured because of a lack of a helmet (say, influenced
MV> by "macho" peers like you encouraging him not to wear a
MV> helmet)?

My first answer would be to try and prevent injuries to child cyclists by
promoting better cycle education programs in schools. Promoting helmets would
obviously play a part - encouraging children to think wearing a helmet is
trendy. But you can really do a lot more to improve the safety of child
cyclists by proper training and education than by forcing them to wear a
helmet or give up cycling.

My second answer is that I'm really beginning to doubt the efficacy of
mandatory helmets in preventing even head injuries. As you have probably
heard, in the first year of mandatory helmet legislation in victoria, child
cycling went down by 36%, child head injuries went down by 32%. Where's
the benefit in that? Yes there were fewer cyclists, but apparently the risk
of head injury was not reduced for any individual cyclist.

Other data confirm the changed road conditions. Following the
introduction of speed cameras, the proportion of motorists speeding fell from
23% in December 1989 to 4% in June 1993 (Williamson, 1993). Impact speeds
affect head injuries. Janssel et al., (1985) estimated that, for
vehicle-cyclist accidents, for a drop in impact speed from 40 to 30 km/hr,
head impact acceleration would fall by 50%

Cyclists, it seems, have not been so lucky. Most estimates suggest that,
following mandatory helmet legislation, injuries have gone down by less than
the numbers of cyclists, representing an increase in the injury rate per
cyclist. This appeared to be the case for hospital admissions from bicycling
accidents in Victoria, as noted above. Since children are usually considered
to be particularly at risk, it is interesting to consider relevant statistics
for children. Numbers of head and other bicycling injuries were available
from the Victorian Injury Surveillance System (VISS), which monitors accident
data for children under 15 from five Melbourne hospitals.
Surveys taken in May/June 1990, 1991 and 1992, reported by Cameron et al.
(1992), indicated that total children's bicycling activity had reduced by 36%
in the first year of the helmet law, and by a total of 45% in the second
year.

Mandatory helmet legislation in Victoria was estimated to reduce cycling
activity by 36% in Melbourne. Numbers of cyclists counted on the road went
down by even more - 42% Numbers of head injuries using hospital admission
data for bicycle injuries went down by 37% (1000 or more data points each
year). If, Thompson and Rivara's estimate of an 85% reduction in head
injuries from helmet wearing were correct, this simply would not be
possible.

Before mandatory helmets, 31% of cyclists observed on the streets wore
helmets. Afterwards, 75% did. Working on the before and after percentages
of head injuries, these figures imply that a helmet has a 27% chance of
preventing a head injury for a cyclist involved in an accident. But they
also suggest a 20-30% increase in the accident rate, so that head injuries in
total are no different, but the chance other equally debilitating injuries
such as facial or spinal would appear to have increased.

In towns where lots of people cycle to work (The Bicycle Planning Book
(1978) quotes Cambridge as having 30% of people cycling to work, Peterborough,
25%), drivers become aware of cyclists and it becomes safer and a more
acceptable behaviour. You are no longer a nutcase, or a freak for doing so.
Town and transportation planners consult and provide for cyclists. A
measure such as mandatory helmets, without which there would be two thirds
more cyclists on our roads, seems to be the worst possible way to get people
cycling.

If you provide statistics to show me that the head injury rate (or the total
medical cost of injury) per cyclist, or per mile cycled, is lower for American
helmeted cyclists, than either Dutch non helmeted cyclists, or cyclists in
some of these British cities where lots of people cycle to work, then your
case is proven.

If not, then maybe Governments should be doing other things. Encouraging
voluntary helmet wearing, education programs in the schools, more speed
cameras, more random breath testing, policing of all traffic laws, and
especially driver education.

All of these things have been shown to work and significantly reduce deaths
and injuries on the roads. Mandatory bicycle helmets have not, except by the
amount they have caused people to give up cycling.

From: D. Robinson
Newsgroups: rec.bicycles.misc
Subject: Re: Helmet cost/benefit ratio
Date: 1 Feb 94 23:04:58 GMT
Eric Wassermann wrote:
EW> Avery Burdett wrote:
EW> AB> One other point, nobody has yet figured out what the effect of
EW> AB> the increased G force is when you add three quarters of a pound
EW> AB> to a head. This is of particular concern with small children
EW> AB> because the increase in weight is that much greater on a small
EW> AB> head.
EW> As you may have been saying above, the additional risk
EW> imposed by the helmet mass in the case of small children is not
EW> so much to the head as to the cervical spine. For all I know,
EW> this could be a major concern. No one I've talked to has much
EW> to say about it, however.

I think there is some data on this. McDermott et al. (Trauma, 1993, p834-841)
found a significant increase in neck injuries for helmet wearers (3.3% Of
unhelmeted riders sustained neck injuries while 5.7% Of helmeted riders
sustained neck injuries - a 75% increase in helmet wearers, but not a
particularly large effect overall). That compared 366 helmeted riders and 1344
non helmeted riders admitted to hospital in Victoria before helmets were
mandatory.

His estimate of the probability of preventing a head injury for cyclists
over 18 was 25% (28.6% Of helmet wearers had head injuries while 38% of non-
helmet wearers had head injuries). This is probably about right. The
problem is a that a 25% reduction is peanuts, compared with increased accident
rates from reduced motorist awareness from the huge reductions in cyclists on
the roads, the loss of health benefits from causing people to give up cycling
and the other measures such as enforcement of speed limits can have on the
head injury rates for both pedestrians, cyclists and even car occupants. [I
changed wording here --DC]

An Assessment of the Mandatory Bicycle Helmet Law in Australia
by D. L. Robinson

Estimate of the maximum benefit from helmet wearing:Using the hospital data and the estimated changes in helmet wearing in the
year before and after the helmet law, it is possible to obtain an upper value
for the probability that wearing a helmet will prevent head injury. As shown
in calculation 1, this works out at 27%. Some of this is likely to be due to
the changed road conditions noted earlier which affected admissions resulting
from collisions with a motor vehicle. Overall, the estimated benefit of
helmet wearing is consistent with estimates by McDermott, Lane, Brazenor et
al. [1993]. In a retrospective study of 261 cyclists wearing approved
helmets, 105 wearing non approved helmets and 1344 unhelmeted casualties
admitted to Melbourne or Geelong public hospitals following bicycle accidents
in 1987-1989, a reduction of 25% in head injuries was observed for cyclists
aged 18 or over wearing approved helmets and a 31% reduction for female
cyclists. Neither reduction was statistically significant. The overall
reduction was estimated to be 39% (not adjusted for age or sex of rider), but
head injury was significantly more frequent in helmeted riders over 18 (P <
0.001). Older riders were also more likely to be struck by a motor vehicle
(32.9% vs 26.1%). McDermott's Table 1 shows male riders wearing approved
helmets were significantly younger than unhelmeted riders (averaging 15.6 vs
17.8 years, P < 0.002) and some of the apparent difference in head injury
rates may have been due the age differences in male riders. The estimates for
riders over 18 or for female cyclists may therefore be a better estimate of
the benefit of helmets.

Literature estimates of the benefit of helmets have varied widely. A Swedish
report estimated they would prevent 13% of head injuries [ECF, 1991]. Mills
[1989] estimated helmets could prevent 32% of head injuries in the UK, but, in
the US, Thompson et al. [1989] estimated 85% would be prevented. The
latter was based on observing only 23 head injured cyclists wearing helmets
out of a sample of 325 (7.8%), compared with 23.8% helmet wearing in a control
dataset of non head injured cyclists receiving emergency room care.
Attempts were made to adjust the odds ratios for age, sex, income, education,
cycling experience and the severity of the accident. Those who choose to wear
helmets may differ in many respects from those who do not, including traffic
conditions and type of roads used for cycling, so comparison of dissimilar
samples using statistical adjustment techniques will always be difficult.
Applying Thompson's estimate of an 85% reduction in head injury to the
28.6% of approved helmet wearing riders over 18 with head injuries in
McDermott's study would imply a very unrealistic head injury rate of 191% in
non helmeted riders, very different to the actual value of 38%. Thus we
may conclude that Thompson's estimate of the reduction in head injuries is not
valid for hospital admissions in Victoria, though helmet wearing has some
benefit in reducing the number and severity of head injuries for cyclists
involved in accidents.

(This article is reproduced from the newsletter of World Without
Cars, a group based in Windsor, Ontario. The piece originally
appeared in the Journal of the Canadian Medical Association).

Expressed in potential life-years gained versus potential life-years lost, Dr.
Mayer Hillman estimates that regular cycling's net benefit to personal
health outweighs its risk of injury by a factor of 20 to 1, even in a
country as hostile to cycling as Great Britain (Hillman, M. Unpublished
presentation at Velo Mondiale/Pro-Bike/Velo-City Conference, Montreal,
September 1992.).

SC?> However, I was disappointed to see that none of them were wearing
SC?> helmets.
SC?> In addition, California recently enacted legislation that makes it
SC?> illegal for minors under the age of 18 to ride without a helmet!
SC?> Currently only warnings are being given, not citations. Chelsea
SC?> and an unidentified school-friend of hers were in clear violation of
SC?> this new law.

That's great! I'm glad to see our first family believes in direct action,
protesting these stupid laws. :) I put that smile regarding the direct
action, which I'll bet is not the case. But, these laws are stupid,
blaming the victim, see below.

SC?> In fact, the O.C. Register reported that Chelsea's friend was hurt
SC?> when her bike ran into an opening door of a pick-up truck. Luckily
SC?> she got away with only minor bruises.

Let's see. Who's at fault here? The bicyclist for not wearing a helmet
or the driver for opening a vehicle door without looking? See, the helmet
laws can end up blaming the victim.

SC> And to believe these are stupid laws and yet think it's
SC> wise for the Prez to set the best possible example for the world.

Riding a bike with or without a helmet is a great example. Riding a bike
without a helmet is better than not riding a bike at all. Fine, it is
better to ride a bike with a helmet than ride a bike without a helmet, but
helmet legislation ends up deterring more cyclists than it saves.

SC> I think in your zeal to register your distaste for helmet laws you're
SC> confusing two quite different things.

THE CASE IS: DO MANDATORY HELMET LAWS HELP MORE PEOPLE THAN THEY HURT?

NO!

From all the research I've seen on the topic, which is A LOT, the answer
is clearly no. The few people it saves are far outweighed by fewer people
cycling and thus there is more illness and energy use.

VR> My reply:
VR>
VR> The public has a stake in your conduct on the open road.
VR>
VR> For example, suppose I am an excellent driver, but I have a
VR> single, momentary lapse of good sense, and I strike you on your
VR> bike. You are not wearing a helmet and are killed. Now I am
VR> driven into bankruptcy by your family's lawsuit, and I am doomed
VR> to bear the guilt of killing another human being. I am shattered,
VR> destroyed, a pariah and a vegetable for the rest of my days.

If you are willing to drive a car, that is a price you may have to
pay. This happens over 100 times every day in the US alone.
And let me point out, that most of the times it happens, a cyclist is not
involved. Driving is very dangerous. If you, or others, are not
willing to suffer those consequences, don't drive.

VR> Suppose, however, that you are wearing a helmet and suffer only
VR> minor scrapes and bruises. I am liable only for the cost of your
VR> bike. I gladly make restitution, resolve to be more careful in
VR> the future, and go on with my life.

Though helmets are helpful, their degree of actual protection in a major
accident is not as great as you think. Most likely, if the accident would
have killed me while not wearing a helmet, the accident would render
serious brain damage if I was. Yes, that's better... I guess... hmm... but
anyway that's another debate. The point is you would probably get sued
anyway, and those hospital bills for dealing with serious brain injury
ain't cheap. And please, don't "resolve to be more careful in the
future," after you have an accident. At that point, it's too late. Be more
careful now.

Now, the point I raised in my previous letter was where the blame is being
pointed. Here, you are clearly laying the blame on the cyclist for the
unhappy or happy ending of the story. In either case, the cyclist got
creamed. Who's to blame for the tragedy? The motorist.

VR> Your right to personal liberty does not extend to increasing the
VR> liability of motorists to such a devastating extent. The common
VR> good of all must prevail.

But drivers' liberty to use their cars end up costing our society dearly.
I agree, the good of all must prevail. It's time to reduce
automobile use. That responsibility rests on each of us as individuals
and on our government in creating public policy.